This document provides an overview of various classes of cardiac medications, including their mechanisms of action, indications, dosages, and side effects. It discusses inotropes, chronotropes, antianginal agents, antiarrhythmics, beta blockers, and calcium channel blockers. For each drug class or prototype drug, key details are provided about how it works, what it is used to treat, typical dosing, monitoring parameters, and potential adverse effects. The document also includes several class participation questions to test understanding.

1. Cardiac Medications Michelle Mungcal, B.S. University of the Pacific Thomas J. Long School of Pharmacy Doctor of Pharmacy Candidate, Class of 2009 January 12, 2009

3. Inotropes

8. Digoxin MOA

16. Chronotropes

22. Anti-anginal Drugs

24. Symptoms of Angina

28. 8 - 12 hr 30 min 1,2,3 mg XR tab ( Nitrogard ® ) 24 hr 30-60 min 2.5 - 15 mg/day Transdermal patch ( Transderm-Nitro ® ) 10 - 45 min 1-3 min 0.3 - 0.6 mg SL ( Nitrostat ® ) 4 - 8 hr 15 min 2% ointment ( Nitro-bid ® ) Nitroglycerin 2 - 4 hr 2-5 min 2.5 - 10 mg SL 5 - 30 mg po qid ISDN (Isordil ® ) 10 min 30-60 sec 0.3 ml inhalation Amyl nitrate (Vaporole ® ) Duration Onset Common Dosage Drug (Trade Name)

33. Antidysrhythmics/Antiarrhythmics

61. Sympathomimetics

64. Epinephrine MOA

67. Vasopressors

74. Diuretics

77. Diuretic Properties Diuretic agent Site of Action & Misc. Chlorothiazide PO/IV Distal Tubule Calcium Reabsorption Increased May transiently increase Lipids, BG and UA Hypomagnesemia (may complicate K+ correction) Severe Potassium Depletion – Creation of Combos ??? Pregnancy categories: B and C Hydrochlorothiazide Indapamide Metolazone (Mykrox) Furosemide Ascending Limb of Henle Ototoxocity (reversible and irreversible) Hypokalemia (supplement with K+) Pregnancy categories: B Torsemide Bumetanide Ethacrynic acid Amiloride Distal and Proximal tubule Impact Hyperkalemia and serum creatinine elevations Avoidance: BUN > 30 mg/dl or SCr > 1.5 mg/dl Triamterene Eplerenone Distal and Aldosterone receptor Impact Same as amiloride and triamterene – avoid K spare combos Spironolactone

82. Anticoagulants

87. Coagulation Cascade

94. Fibrinolytic Enzymes

98. Streptokinase (cont’d)

99. Beta Blockers

105. Calcium Channel Blockers

109. Amlodipine http://online.factsandcomparisons.com/MonoDisp.aspx?monoID=fandc-hcp10122&inProdGen=true&quick=Amlodipine&search=Amlodipine